| Objectives:To evaluate the effect of a abstinence before surgery operation on the comfort,security,the incidence rate of intraoperative and the postoperative complications,hospitalization days,hospitalization expenses,the degree of edema of esophageal mucous and the cleanliness of esophageal mucous during routine gastroscope patients who with POEM surgery;to improve the cognitive of medical staff for conducting a abstinence and to improve the compliance of patients who with a abstinence before POEM surgery operation,and then to reduce the incidence of complications related to the operation,the hospitalization days and the hospitalization costs,and provide a reference basis for promoting patients recover,abstaining fasting drink mission for the future clinical work,ensuring the operation of security;to provide a scientific basis for the standardization of the nursing routine during the perioperative period.Methods:126 patients who will conduct a POEM surgery were randomly divided into group A(n=43,all the patients were forbidden eating and drinking for 8h before the POEM surgery),group B(n=40,all the patients were forbidden eating for 24h but forbidden drinking for 8h before the POEM surgery)and group C(n=39,all the patients were forbidden eating for 48h but forbidden drinking for 8h before the POEM surgery)according to the start time of preoperative fasting state.All the patients were interviewed on the first day in hospital while collecting all the patient’s general information,including the gender,age,duration of disease,body mass index(BMI),diet,family history of achalasia,esophageal manometry,esophageal manometry and medication history.All the patients were informed the diet pian and the surgical considerations on the first day in hospital.All the patients must be unified to eat the same rice juice which provided by the hospital nutrition canteen for about two days before entering hospital,then adjust to the diet according to the patient’s enrollment after two days later.The incidence of preoperative hunger and anxiety was observed and recorded.The esophageal cleanliness,esophageal mucous edema,number of intraoperative and postoperative complications and days of hospitalization during preoperative endoscopic examination were evaluated and recorded.All of the data were input into and analyzed by the database with the software of SPSS 22.0,thedifference in the two groups was analyzed using independent t test,Wilcoxon Mann-Whitney test,analysis of repeated measurement variance and chi-square test,P<0.05 for the statistical difference.Results:1.The patient’s general information and disease related:Three groups of patients in ordinary information such as age,gender,diet,there was no statistically significant difference(p>0.05).Three groups of patients in BMI,esophageal pressure and esophageal diseases such as type of subsection,family history,Eckardt score data comparison,there was no statistically significant difference(p>0.05).2.The patient comfort index:Three groups of patients with preoperative hunger,difference was statistically significant(x~2=6.302,p<0.05).Longer duration of fasting,hunger,the incidence hunger of group A is 16.3%,the incidence hunger of group B is17.5%,the incidence hunger of group C is 17.9%.Three groups of patients with preoperative thirsty feeling comparison,difference was statistically significant(x~2=26.35,p<0.01).As the extension of fasting time,enhanced sense of thirst,the incidence thirst of group A is 14.0%,the incidence thirst of group B is 22.5%,the incidence thirst of group C is 71.8%.Three groups of patients with preoperative anxiety,there was no statistically significant difference(x~2=1.578,p>0.05).A group of patients with preoperative anxiety incidence 23.3%,B group of patients 30.0%incidence of preoperative anxiety,35.9%incidence of preoperative anxiety in patients with group C.3.The patient safety indicators:Esophageal mucosal edema degree to compare,there was no statistically significant difference(x~2=0.269,p>0.05).A group of patients with mild mucosal edema,28 cases,severe mucosal edema,15 cases;B group of patients with mild mucosal edema 27 cases,13 cases of severe mucosal edema;Group C in patients with mild mucosal edema,28 cases,11 cases of severe mucosal edema.Cleanness of esophageal mucosa comparison,the difference was statistically significant(p<0.05),in patients with esophageal cleanliness the ideal group C.Longer duration of fasting,ban drink,cleanness of esophageal mucosa increased percent of pass.A group of patients with esophageal mucosa cleanliness percent of pass is53.5%;Group B patients with esophageal mucosa cleanliness percent of pass is82.5%;Cleanness of group C in patients with esophageal mucosa percent of pass is87.2%.Compared three groups of patients with intraoperative complications,the difference was statistically significant(p<0.05),the lowest incidence of complications was 22.5%in group B patients who:including gas related complications difference was statistically significant(p<0.05),the lowest rate in group B is 10%;Mucosal injury incidence rate difference was statistically significant,with A group for the worst;Intraoperative bleeding,no statistically significant difference(p>0.05).Three groups of patients with postoperative complications,the difference was statistically significant(p<0.05),group B incidence of postoperative complications in patients with A minimum of 32.5%,the incidence of postoperative infection compared difference was statistically significant(p<0.05),with A group of patients with infection rate;Pain compared to the difference was statistically significant(p<0.05),the lowest incidence of group B patients pain is 15%;Postoperative complications compared with gas related there was no statistically significant difference(p>0.05).4.Patients economic indicators:the average comparative differences of such confinement three groups of patients was statistically significant(F=4.18,p<0.05),average shortest such confinement in group B patients;The average hospitalization cost compare three groups of patients with difference was statistically significant(F=4.52,p<0.05),average hospitalization expense lowest in group B patients.Conclusion:1.The preoperative fasting for 24 hours,ban drink eight hours group the lowest incidence of intraoperative and postoperative complications,Short of such confinement on average,the average hospitalization cost is low,can be used as a perioperative clinical dietary management solution.2.Preoperative fasting for 48 hours,ban drink eight hours group of patients with a high incidence of hunger,thirst,poor comfort;The highest cleanness of esophageal mucosa. |
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